The Ethical Issues With America’s Private Adoption System

Author and researcher Gretchen Sisson shares her insight on the pitfalls of America’s adoption system.

At a time when reproductive rights are being increasingly restricted across the country, politicians often cite adoption as an obvious and ethical alternative to abortion. But Gretchen Sisson, Ph.D — one of the country's foremost adoption and abortion researchers — begs to differ.

Sisson is a qualitative sociologist studying abortion and adoption at Advancing New Standards in Reproductive Health (ANSIRH) in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco. Her research was cited in the Supreme Court’s dissent in Dobbs v. Jackson Women’s Health Organization, and she released a new book earlier this year on the state of America’s private adoption system.

Tilted “Relinquished: The Politics of Adoption and the Privilege of American Motherhood,” the book features hundreds of interviews with women who’ve given children up for adoption, ultimately arguing that the United States’ private adoption system seeks to separate families for profit rather than offering the necessary supports to struggling mothers who, in most cases, wish to parent their children.

“Contrary to the political conversation that juxtaposes abortion and adoption, the vast majority of the mothers that I interviewed never tried to get an abortion. Almost all of them wanted to parent their children — that's why they continued their pregnancies,” Sisson tells Healthnews. “It wasn't until parenthood felt untenable or impossible later in their pregnancies that they turned to adoption.”

Healthnews spoke to Sisson about her research and what she discovered about America’s adoption system in the process.

Q: What inspired your research into adoption in the U.S.?

A: My work in adoption really came out of my time working with pregnant and parenting teenagers when I was in graduate school and looking at the ways that different motherhood was supported and valued and then ultimately, stigmatized and marginalized. I really wanted to understand the gap between what we believe to be true about young mothers and what their lives actually look like. This came up again around adoption and the sort of political and rhetorical and cultural ideas of what adoption offers, not just mothers, but children and prospective parents. I wanted to probe that more deeply and understand the ways that adoption was actually impacting the mothers who were relinquishing.

Q: You spoke with hundreds of women from all walks of life who relinquished their children for domestic adoption — what did you find?

A: For most of them, the relinquishment was really a crisis response. It was a function of not having the support that they needed, or felt that they needed, in order to parent at a certain point in their pregnancy. We like to put mothers on a pedestal. We like to say that we are supporting families, but we do very little to actually tangibly make parenting easier for people.

Things like accessible, affordable housing, living wages, health care, child care and good early childhood education — all of these pieces make raising a family, especially in children's earlier years, feel really possible. Those are things that the United States chronically, intentionally underinvests in. And these are things that mean so many American families are falling through the cracks, right? I think adoption is really a function of which families are most vulnerable to separation within that system.

Q: Which families are most vulnerable?

A: Different families are separated for different reasons through parallel systems. My work focuses on the private system, which is an adoption system that was born out of a market demand. We have this idea that we have so many adoptable babies and that we need more families who want to adopt. That's not true. We have up to 45 waiting families for every infant that's relinquished. So you have this market where you have very, very high demand and very low supply. You have an industry that is designed to promote and market the idea of adoption as a meaningful solution.

Historically, that has been a very white system. That's where the market demand was. That is not as true anymore. There is now a market demand for all babies simply because as international adoption continues to fall, greater and greater demand is placed on domestic adoption. But historically, that was the basis for separation, so it was mostly white families that were separated for adoption.

In parallel, you see families of color, and particularly Black families, targeted by the child welfare system that acts as a family policing system as far as regulating and extracting a type of control for those types of vulnerable families. And so you have both of these systems that are separating vulnerable families for different reasons to different ends. But today, they are becoming increasingly similar because poverty is what makes families vulnerable to both the public and the private systems of adoption.

Q: Tell me a little bit more about the ethical issues with adoption as a solution to issues that families face.

A: When a lot of people hear “adoption,” they think of it as a positive thing. They hear that children need families, and they don't really know much more than that. But again, most of the mothers that I interviewed wanted to parent their children and could have parented their children with fairly minimal support. If they had had access to stable, affordable housing, if they had access to a car seat, if they had food assistance, or any of those things that could have helped them through a short term crisis, they would be raising those children.

So it's hard to say that the children that are available for adoption are legitimately children in need of a family, when a relatively small investment in their family of origin would have kept them there.

Some of the mothers that I interviewed were in harder sets of circumstances, so they were entirely unhoused, maybe they were struggling with addiction, some of them were incarcerated. And that I think requires a broader sense of what our social obligation is. When we live in a country that continues to incarcerate people, you are going to have children that are made available for adoption because their parents are incarcerated. Now, we should also be thinking longer term about what it means to preserve that relationship to create the potential for reunification down the line.

But to me, the bigger question is how are we supporting families from the outset so that these mothers can raise the children that they want to raise rather than putting continual public investment into a private industry that is designed to promote the idea of separating parents from their children.

Q: Why isn't adoption a good solution to the lack of abortion access in the U.S.?

A: There’s upwards of 850,000 to a million abortions in this country per year, and only around 20,000 private domestic adoptions of infants. Most women who are relinquishing didn't try to have an abortion, and abortion patients are highly uninterested in adoption.

There was a survey of abortion patients that asked if they were interested in an adoption, and exactly 0% said “yes.” It's not that knowledge of adoption is low — people know about adoption, they're just generally not interested in it. So you have abortion patients who aren't interested in adoption, and you have relinquishing mothers who largely aren't interested in abortion.

When you deny people access to abortion, we found that the vast majority of them parent. Over 90% of the women that we looked at who were denied access to abortion were parenting the child to whom they gave birth. So when you talk about the impact of abortion bans, you're going to have far more women parenting in circumstances that they did not plan than you are going to have people relinquishing infants as a result of that denial of care.

Our political framing puts abortion and adoption in contrast so much that it's hard for us to understand the extent to which they are really unrelated for most people who are making decisions about a pregnancy.

Q: What does your research tell us about the state of reproductive justice in America?

A: It’s really necessary to understand the ways in which we define reproductive autonomy and the ways in which that includes not just access to pregnancy planning and abortion care, but also the ability to continue pregnancies and circumstances that you can control and plan.

Another aspect of reproductive justice is making sure that people have the resources and the safe communities and the support that they need to parent the children that they want to, and adoption is really a failure to account for that.